AccountId: 011433970860
ContactId: 2fa88486-b963-40da-bf77-cb8bf62f63ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351700 ms
Total Talk Time (AGENT): 125185 ms
Total Talk Time (CUSTOMER): 145234 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/2fa88486-b963-40da-bf77-cb8bf62f63ca_20250530T17:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I was calling for verification of benefits for patients.
[CUSTOMER][NEUTRAL] it's a.
[AGENT][POSITIVE] I can help you with benefits. Can I get your name and a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII] and a callback number is [PII].
[AGENT][NEUTRAL] And do you have the policy number with you?
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] I have let's see what we got, yeah, I have D as in David 45401578.
[AGENT][NEUTRAL] And is that the member ID?
[CUSTOMER][POSITIVE] I believe so, correct.
[AGENT][NEUTRAL] Is there anything that says um policy certificate number or um
[CUSTOMER][NEUTRAL] Teacher certificate
[AGENT][NEUTRAL] What would the other name be?
[AGENT][NEUTRAL] Policy certain number or anything like that?
[CUSTOMER][NEUTRAL] Yeah, policy er number I have that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It's 02587320.
[AGENT][NEUTRAL] I have 02587370. Is that correct?
[CUSTOMER][NEUTRAL] 2,020,320
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Let me pull that up real quick.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It is, it is [PII], so it's [PII] Last name is [PII], so it's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] Thank you so much for verifying that for me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're wanting eligibility?
[CUSTOMER][NEUTRAL] Correct, verification of benefits for just a routine office visit.
[AGENT][NEUTRAL] OK, it looks like this policy is active with an effective date of [PII]. It is active. Um, let me see if office visits are covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because this is a hospital indemnity policy, so give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is a hospital plan. She's see if it covers a hospital identity is what he said.
[CUSTOMER][NEUTRAL] So what am I gonna do like.
[AGENT][NEUTRAL] Um, I'm not seeing office visits is covered. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Where I
[CUSTOMER][NEUTRAL] Is he still out there? Is he still out there?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So he does not have coverage for office visits you say?
[AGENT][NEUTRAL] Uh, I don't, I don't see it on here. Let me read the actual policy just in case.
[CUSTOMER][NEUTRAL] Uh, hold on.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] But the bus.
[AGENT][NEUTRAL] And it's just a routine wellness exam? Is that what it is?
[CUSTOMER][NEUTRAL] Yeah, I'll go bowling.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, no, it looks like this policy does have a physician's office, but it's only due to, uh, an accident or illness, and, and it's to receive treatment in the physician's office. It's not just a
[AGENT][NEUTRAL] For this policy, there isn't an office treatment writer.
[CUSTOMER][NEUTRAL] OK, but if he does have something he's being seen for an issue like um, I guess, uh, an issue, a medical situation, can he, will it be covered for that?
[AGENT][NEUTRAL] Uh, it looks like, and this is just a verification of benefits, not a guarantee of payment. Um, it looks like they do have an outpatient accident and sickness treatment benefit in a physician's office of up to $100 per day.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Uh, with a maximum of 4 days per calendar year. So if it's due to an accident or illness, and they're being treated in the physician's office, it looks like it should cover that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK, hang on for one second please, OK? It, it would cover it if he was being seen for an injury, accident, or um an illness to be treated for.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] I know, but let me.
[CUSTOMER][POSITIVE] OK. OK. Well, thank you so much.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Great, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.